Preventing Eating-Related and Weight-Related Disorders: Collaborative Research, Advocacy, and Policy Change

3. Public Health Interventions for Body Dissatisfaction and Eating Disorders: Learning from Victoria

chapter three Public Health Interventions for Body Dissatisfaction and Eating Disorders: Learning from Victoria Susan J. Paxton, La Trobe University The need for the prevention of body image and eating disorders using a public health approach has been increasingly recognized as the extent of the burden of these disorders is better understood. If an effective population -based means of preventing body image and eating disorders could be identified and implemented, much pain and suffering would be alleviated. However, only in a few countries has the attention of public health policymakers turned to this task. This chapter will first consider the history and rationale for public health approaches to prevention and then explore possible targets for public health intervention. The state of Victoria in Australia is one place in which serious attention has been given to public health initiatives to reduce body image and eating disorders, and approaches that have been explored in Victoria will next be described. The final section of this chapter explores future challenges for public health interventions in this field. Public Health Approaches to Prevention Public health is evolving, but at its core it emphasizes the health of populations rather than of individuals––that is, public health interventions endeavour to improve health through population-level interventions rather than through interventions targeting specific individuals at the highest risk of disease (Baum, 2008). In her exploration of the history of developments in public health, Baum (2008) proposes that the 1970s and 1980s saw a growth in the recognition of the role of lifestyle in influencing health and illness, with Canada being the first country to incorporate 7 1 7 2 S u s a n J . P a x t o n notions of a healthy lifestyle into its health policy (Lalonde, 1974). There followed campaigns that aimed to increase health-promoting behaviours such as increasing physical activity and quitting smoking. Baum (2008) proposes, however, that at the heart of many of these interventions was the assumption that individuals were responsible for making their own healthy lifestyle choices. The 1986 Ottawa Charter for Health Promotion introduced the “new public health” orientation, marking a turning point in the focus of public health.1 In this charter, factors outside individual control were viewed as playing critical roles in health. Factors noted as particularly influential were government policies such as those related to education, wealth distribution , and social environments. The charter recommended the creation of social, economic, and physical environments that would support health. Thus, implementation of new public health policies clearly required government endorsement and active involvement. However, in Australia, as in other countries, practical government support for new public health philosophies has been inconsistent. In Australia, the Conservative national government under Prime Minister John Howard (1996-2007) promoted policies that supported individualism, personal responsibility, and private health care rather than community development based on new public health goals (Baum, 2008). In addition, as Baum (2008, p. 41) has noted, new public health goals are frequently contrary to those of business and require “an oppositional position in regard to the profit-making activity of many other sectors.” Not surprisingly, governments across the LiberalConservative spectrum are frequently reluctant to take on such interests. However, government involvement in public health interventions is highly desirable, as governments have at their disposal a number of tools to bring about changes that may promote healthy social and physical environments . Governments can, for example, legislate for change. Prominent examples of the effectiveness of this approach have been the legislation for the compulsory use of seatbelts in cars and helmets on bicycles and of smoking bans in public places. Taxation policies are another tool that may promote healthy behaviours, such as having no taxes on fresh foods but high taxes on tobacco (World Bank, 1999). Governments may also promulgate and monitor non-binding codes of conduct that outline responsible industry behaviour. Importantly, governments can provide public funds for the development, evaluation, refinement, and dissemination of health-promoting activities such as community-based and school-based prevention activities and for universal health promotion campaigns such as media and billboard advertising. Interventions of this kind may be designed and delivered by governments, government instrumentalities P u b l i c H e a l t h I n t e r v e n t i o n s f o r B o d y D i s s a t i s f a c t...